Depression, or just teen angst?

How do you recognize a serious problem, and how do help your teenager get through it?

I have been a high-risk teen counselor for over 25 years and I have answered thousands of phone calls on the ACTION 1-800-For-Teen Helpline. Many of these calls are general parenting calls, seeking advice on how to set boundaries for difficult teen behavior or from parents who are concerned that things are "just not right" and they are looking for suggestions on how to explore what is going on with their teen.

Your teen sulks and is irritable. He or she is angry, acts out, rebels. Nothing you say or do seems to help. Changes in eating and sleeping habits occur - eating or sleeping too much or too little. You notice a significant weight gain or loss in your teen. Your teen is missing school, or there is a sudden decline in grades. He or she withdraws from family and friends, and is no longer enjoying activities that were once pleasurable. Indecision, lack of concentration and forgetfulness are apparent. Your teen is beginning to overreact to criticism, feeling nothing is worth the effort. You find notes to friends and dark poetry that talk about thoughts of death or suicide. There is even evidence of drug and alcohol abuse.

Is this normal teenage behavior or perhaps a clue to something more troubling?

Such symptoms may be warning signals of teen depression. Teen depression has skyrocketed in the last 30 years. Along with teen depression there has been a dramatic increase in teen suicides. Teen suicides are the third leading cause of death for teens, with car crashes and homicides being the first and second leading cause of teen deaths.

Occasional melancholy, bad moods and short periods of feeling down are common in teens. Major depression, however, limits a teen's ability to function normally. Depression in teenagers is characterized by a persistent sad mood, irritability, feelings of hopelessness or the inability to feel pleasure or happiness for an extended period of time - weeks, months or even years. Depression affects a teen's thoughts in such a way that the teen doesn't see when a problem can be overcome.

It's as if the depression puts a filter on the teen's thinking that distorts things.

TriggersThe reasons for depression can vary from teen to teen. Often, depression results from a number factors:- Significant events such as the death of a loved one, parents' divorce, moving to a new area, or breaking up with a girlfriend or boyfriend can prompt symptoms. Teen depression can occur from neglect, prolonged absence from someone who is a source of care and nurturance, abuse and bullying, damage to self-esteem, or too many life changes occurring too quickly. In some teenagers, any major change may provoke depression.

- Earlier traumatic experiences such as abuse or incest often emerge and cause great distress as a child becomes a teen. This is because as a young child the victim did not have the life experience or language to process these painful experiences, or to protest. When such memories emerge in adolescence, the distress can be compounded if adults deny or discount the information.

- Stress, especially if the adolescent lacks emotional support can be a trigger.

- Hormonal/physical changes that occur during puberty also cause new and unexpected emotions. Moodiness and melancholy are often experienced and labeled as depression.

- Medical conditions such as hypothyroidism can affect hormone balance and mood. Chronic physical illness also can cause depression. When a medical condition is diagnosed and treated by a doctor, the depression usually disappears.

- Substance abuse can cause changes in brain chemistry.

- Allergies to foods such as wheat, sugar, and milk cause or exacerbate symptoms of depression.

- Nutritional deficiencies may be caused by an amino acid imbalance or vitamin deficiency.

- Genetics can predispose a teen to depression when the illness runs in the family.

IndicatorsWhatever triggered the depression, depression is a serious disease and while many teen behaviors or attitudes are annoying to adults, they are actually indications of depression. Such indicators can include drug and alcohol use. Depressed teens often use substances in an attempt to self-medicate their symptoms. Depression can intensify feelings of ugliness and unworthiness, resulting in low self-esteem.

Eating disorders such as anorexia, bulimia, binge eating, or yo-yo dieting are often signs of unrecognized depression. Cutting, burning, head banging, or other kinds of self-mutilation are almost always associated with depression. Acting out, agitation, aggression, or high risk behaviors rather than or in addition to gloominess is a sign of depression. Teens who are seriously depressed or despondent often think, speak or make "attention-getting" attempts at suicide, and should be taken seriously.

What to do?It is difficult for caring, concerned parents to see their children struggling. Sometimes parents wonder if their teen is being melodramatic or "just trying to get attention" with challenging behavior. Even if that were the case, it would indicate a need for some appropriate response.

The first problem is to distinguish between a more serious depression and "normal," typical adolescent moodiness, caused by hormonal changes and brain growth spurts. For example, it is common for girls to become moody, edgy, and anxious just before and during menstruation, and maybe even longer, if she suffers from hormonal problems. If grouchy behavior seems to have a pattern or cycle, it is likely the symptoms are tied to hormonal changes, and are not indicative of clinical depression. In contrast, one hallmark of clinical depression is the tendency to become isolated - to stop talking to family, and to stop spending time with friends - and this kind of moodiness does not seem to lift after a couple of weeks.

Rushing to a therapist when symptoms are actually within the range of normal can have several negative effects including the teen feeling like there must be something wrong with himself or herself, which can tip a fragile balance toward lowered self-esteem. Medications may be prescribed unnecessarily, and without careful monitoring.

Suspect depression?- Respond with love, kindness, and support.

- Repeatedly let your teen know that you are there, whenever she or he needs you.

- Be gentle but persistent if your teen shuts you out (depressed teenagers do not want to feel patronized or crowded). Do not ask a lot of questions, but make known your concern and your willingness to listen.- Do not criticize or pass judgment once your teen begins to talk (the important thing is that he or she is talking and communicating feelings).

- Encourage activity and praise efforts to socialize and be active.

- Seek help from a doctor or mental health professional if the adolescent's depressed feeling doesn't pass with time. Be prepared to list behaviors, note how long and how often they have been occurring, and how severe they seem.

- Do not wait and hope that symptoms will go away on their own. When depression is severe - if teens are thinking about hurting themselves or about suicide - seek professional help as soon as possible.

- Parents of depressed teens may themselves need support. Seek out groups of parents who have experience with teen depression.

The single most important thing a parent can do to break down the social isolation that is at the heart of their teen's problems is to listen. Listen when your teen talks. Don't try to talk them out of their feelings or solve their problems, just acknowledge the pain and sadness they are feeling. Don't compare your teen's feelings, reactions or experiences to your own or to someone else's.

A parent can - and should - express their concerns directly. It is not easy to connect with teens in this way, and parents may need professional guidance to assist them. Yes, it is likely that the teenager will get angry and will say harsh things ("It's none of your business!" "Get out of my room!" "I hate you!"), but this kind of response is often an unintentional test to see if you are really able to help them. Depressed teenagers will seek answers to the following questions before confiding in an adult:

- Will you be able to handle my big feelings? (Often children will keep their feelings inside if they worry that their parents already have too much on their minds or are depressed themselves. If you yourself are experiencing depression or extreme stress, get your own help and support so that you can better help your child.)

- Can I trust you to hang in there with me, even when I act like this?

- Can I rely on you to be here for me and not to walk away or push me away?

- Will you provide a strong and safe place for me - walls that do not cave in even when I push them?

- Will you love me even when I don't know how to love myself or you?

Parents who show their teens that disagreements and painful feelings can safely be expressed - and that they can be resolved - make it safe for their teens to open up to them. The sharing of confusion, sadness, loneliness, shame, and other strong emotions often decreases the intensity, and opens the way for real communication, which in turn reduces the isolation that is such a large part of depression.

TreatmentDepression is commonly treated with therapy or with therapy and medication. A combination of approaches is usually most effective:- Cognitive-behavioral therapy focuses on the causes of the depression and helps change negative thought patterns.

- Group therapy is often very helpful for teens, because it breaks down the feelings of isolation that many adolescents experience. (Sometimes it helps just to know that "I'm not the only one who feels this way.")

- Family therapy as an adjunct to individual therapy can address patterns of communication and ways the family can restructure itself to support each member, and can help the teenager feel like others share the responsibility for what happens in the family.

- Physical exercise is helpful in lifting depression, as it causes the brain's chemistry to create more endorphins and serotonin, which change mood.

- Creative expression through drama, art or music is often a positive outlet for the strong emotions of adolescents.

- Volunteer work is sometimes helpful for adolescents. Helping someone else whose problems are greater than one's own offers a perspective and also an opportunity to be helpful, which can increase one's sense of purpose and meaning.

- Medication for depression should be used with great caution, only under careful supervision. Recent studies by the FDA have led to warnings that not all psychiatric drugs may be appropriate for teenagers and children. Seek a physician who works specifically with teenagers.

- Hospitalization may be necessary in situations where a teen needs constant observation and care to prevent self-destructive behavior.

Teen hospital treatment programs usually include individual, group and family counseling as well as medications.

- Special schools, wilderness challenges, or "boot camps" are sometimes recommended for troubled teens. These alternatives are intended to help adolescents learn coping skills, develop confidence, learn to trust and work with others, improve academics and/or deal with negative behaviors.

Depression and all the suffering that goes with depression is real.

Depression doesn't make a person "crazy." Just as things go wrong in all the other organs of the body, things can go wrong in the most important organ of all - the brain. Luckily, most teens who get help for their depression go on to have fulfilling, happy teen and adult years - and more importantly enjoy life and feel better about themselves.

Cary Quashen is a certified addiction specialist and the founder and president of ACTION Parent & Teen Support Programs and ACTION Family Counseling. Quashen may be reached at (661) 713-3006. The ACTION Hotline number is 1-800-FOR TEENs. The ACTION Parent & Teen Support Group meets at Saugus High School, Tuesday evenings at 7:00 p.m. in the Q building at the west end of the campus. Saugus High School is located at 21900 Centurion Way, Saugus.